Small-cell neuroendocrine tumor of the bladder: Unexpected long-term survival with carboplatin-etoposide therapy in a patient with metastatic stage disease.

Neuroendocrine small-cell bladder cancer is an extremely rare and aggressive entity, it constitutes <1% of all bladder malignancies. The small-cell neuroendocrine histological variant has a worse prognosis than the classical subtypes. A case of a 53-year-old female consulting with gross hematuria is presented. Cystoscopy revealed a solid aspect lesion involving the posterior wall and dome that was resected. Histopathological findings showed small-cell pure variant carcinoma, high grade, with lymph, vascular, and perineural infiltration, infiltrating the muscle layer. The extension study made by hole body computed tomography scan, showed evidence of multiple lymph nodes and multiple visceral radiological involvements, with pulmonary, hepatic, and peritoneal implants. More than 10 years later, after receiving nine cycles of carboplatin-etoposide remains in complete remission and without radiological evidence of the disease. This is, to our knowledge, one of the longest disease-free survival cases in metastatic small-cell bladder cancer published nowadays.

The definition of ideal training of a urology resident from two different perspectives: trainees vs professors. Is there agreement in their idea of good training?

Introduction: At the end of their residency program, urology trainees should reach the minimum skills required to be able to work by themselves and within a team. To achieve this objective, it is fundamental that the training involves not only surgical activities, but also theoretical, academic, and relational ones. What is the perfect balance between these activities within the ideal urological training? This study aims to evaluate the concordance in different concepts of good urological training between different perspectives (trainees vs professors). Material and methods: Between January and December 2020 the same survey was distributed via email to 967 urology trainees and urology tutors. The survey investigated 5 educational fields: theoretical, clinical, surgical, relational, and simulation. For each field, specific questions investigated the importance of different activities and the training outcomes considered fundamental to be reached by a resident. The questions were evaluated by responders through a Likert 10-point scale. Results: The survey was completed by 155 trainees (58.9%, Group A) and 108 tutors (41.1%, Group B) from 26 different countries. Relative to the tutors, residents assigned statistically significantly lower scores to prostate biopsy (median score 9.11 vs 9.24), robotic simulator training (5.66 vs 5.93), on-call duties with consultants (6.85 vs 7.99), as well as all aspects of relational training (e.g., proper dialogue with colleagues: 7.95 vs 8.88). Conversely, residents assigned statistically significantly higher scores, albeit below sufficiency, to the performance of robotic prostatectomy as a first operator (4.45 vs 4.26). Finally, no discrepancies between residents' and tutors' scores were recorded regarding the remaining items of clinical training (e.g., urodynamics, outpatient clinic, ward duties) and surgical training (e.g., major open, laparoscopic and endoscopic surgical training; all p values >0.05). Conclusions: There was partial concordance between trainees and tutors regarding the activities that should be implemented and the skills that should be achieved during a urological residency. The residents aimed for more surgical involvement, while the tutors and professors, although giving importance to surgical and theoretical training, considered clinical practice as the fundamental basis on which to train future urologists.